HomeMy WebLinkAbout10-1151 ^ ��_ CITY OF DIAMOND BAR I
DEPARTMENT OF COMMUNITY&DEVELOPMENT SERVICES �
21825 Copley Drive,Diamond Bar,CA 91765 �0 M��(j%7f�(�
(909)839-7020 Fax(909)861-3117 Building Inspec�ion o ���e��(')b9j`�9-7027 PRESS
'�"� BUILDING PERMIT APPLICATION FIRMLY
o� JOBSITE �/1/ / ,s�5,�O APPLIC TION PERMIT /� p/C
ADDRESS �7 Lr,f1 DATE �I'/S'/� NUMBE�(/'� #
� APN LOT TRACT �SSUE �+ /� TYPE OCC
�� DATE �f��C ��V � CONST. e�d GROUP
p OWNER (�Zr�D�A�n1Cs�Wf}Y
p ADDRESS ?v�!/ LAS?�nSO ZONING SETBACKS
gcirr f��'���*fa ZIP �I/� TEL. A��nI-y3OJ. FRONT qyy p
APPLICANT GorJY�l l TEL.yo9 Fv3(o /SS�I REAR p
¢ SIDE/SIDE STREET RW ❑
� CONTRACTOR �II So IZvpF' (,� SIDE p
� ADDRESS y(o0 , uvt��o,� I r�
� CITY IZ�vfr'.rt SiDi� ZIP oZ�S� TEL. /�(0 8 {7y99 PROPOSED USE �T�O �X�ST�i�I�.NFLW 7��(c��0:5 �
o L!i F�r E 3% ":� =oW.�u SJra it i�
w ARCH/ENG/
z DESIGNER �I4
w NO.DWEL. NO. NO.
a ADDRESS
� CITY ZIP TEL. UNITS STORIES BEDROOMS
�
N DESCRIPTION SQ.FT. FACTOR PSF ADJ.AREANALUATION
Q OWNER-BUILDER DECLARATION ' SFR/ADD/REM '
O
p I HEiiEBV AFFIRM UNDER PENALTV OF PERIURV THAT I AM EXEMPT FROM THE CONTRACTOqS LI� GHfBgB/CBfPOff
W CENSELAWFORTHEFOILOWINOREASON(SEC.7o31.5BUSINESSANDPROFESSKKJSCODE:MIVCITVOR (n
C� COUNTVWHICHREWIRES�PERMITTOCONSTRUCT,ALTER,IMPROVE,DEMOlISH,ORREPAIRANVSTRUG w
w NRE.PRqR TO ITS ISSUANCE,PL50 REOUIqES THE APPLICANT FOR SUCH PERMIT TO FILE A SIGNED w Patio/Deck
� STATEMENT THAT HE OR SHE IS LICENSED PURSUANT TO THE PROVISIONS OF THE CONTRACTORS LI� �
CENSE LAW(CHAPTER D(COMMENCINO WITH SECTION 7000)OF DIVISION 3 OF TFIE BUSINESS AND FR0. POOUSPB
FESSqNS CODE)OR THAT HE OR SHE IS EXEMPT THEREFROM ANO THE BASIS FOR THE ALlEOED EXEMP- (�
TION.ANYVIOLATIONOFSECTION7071.SBVANVAPPLICANTFORAPERMITSUBJECTSTHEAPPLICANTTO Z pe-ppp} abd
� A CML PENALTY OF NOT MORE TiAN FIVE HUNDRED DOLURS(i500).):
0 ❑I,ASOWNEROFTHEPROPERTY,ORAIVEMPLOVEESWITHWAUESASTHEIRSOLECOMPENSATqN, CORIrtIBfCI01
Z WILL DO THE WORIC,AND THE STRUCTURE IS NOT IN7ENOED OR OFFERED FOR SAIE(SEC.704t,BUSI- � '
� NESS AND VROFESSIONS CODE:THE CONTRACTORS LICENSE UW DOES NOT A7PLY TO AN OWNEH OF �
PROPEHTV WHO BUILDS OR IMPROVES THEREON,AND WHO DOES SUC11 WORK HIMSELF OR HERSELF OR
� THROUGH HIS OR HER ONM EMPLOVEES,PROVIDED THAT SUCH IMPROVEMEMS ARE NOT INTENDED OR m
� OFFEREDFORSALEIF,FIOWEVERTNEBUILDINQORIMPROVEMENTISSOLDWRHINONEVEAROFCAMPIE�
Z TION,THE OWNEF-BUILDER WILL HAVE THE BURDEN OF PROVINO THAT HE OR SHE DID NOT BUILD OR
� pdPROVE FOR THE PURPOSE OF SAL�.
�y,� ❑I.AS ONTIER OF THE PROPERTV,AM EXQUSIVELV CONTRACTINO WITH IICENSED CONTRACTORS
Q TO CONSTRUCT THE PROJECT(SEC.70a�,BUSINESS AND PROFESSIONS CO�E:THE CONiMCTORS U- V0IU9�lOf1 d O � qDJ.AREA
W CENSE UW DOES NOTAPPLV TOAN OWNER OF A PROPERTV WHO BUILDS OH IMPROVES THEFEON,AND
� NMOCONTRACTSFORSUCHPRQIECTSWITHACONTMCTOR(S)LICENSEDPURSUMfiTOTHECONTRAG QUANTITY DESCRIPTION
Y TORS LICENSE UW.). FEE
� O I AM EXEMPT UNDEH SEC. B.8 P.C.FOR THIS REASON � �
?� U
� DATE OWNER �
Z U
� LICENSED CONTFACTORS DECLARATION W
�
I HEREBY AFFlRM UNOER PEN�LTV OF PERJURY TNAT I AM LICENSED UNDER PROVISIONS OF CHAPTER �
� B(COA/MENCWG WITH SECTION 7000)OF DIVISION 3 0F THE BUSINESS AND PROFESSIONS CODE.M!D Z
��� MV UCENSE IS W FULL FOFCE AND EFFECT. m
� LICENSE CIASS UC.NO. �
V DATE CONTRACTOR d
W
� WORKERS'COMPENSATION DECLARATION Q
� 1 HEREBV AFFIRM UNDER PENALTV OF PERIURV ONE OF THE FOILOWING DECURATKKJS: U
� Z
O _I HAVE AND WILL MAINTAIN A CERTIFICATE OF CONSENT TO SELF�INSURE FOR WORKERS' _
Q COMPENSATION,ASPROVIDEDBYSECTION37000FTMELABORCODE,FOHTHEPERFORMANCE U
O OF THE WORK FOF WHICH THIS PERMIT IS ISSUED. �
w �I HAVE AND WILL MAINTAIN WORKERS'COMPENSATION INSURANCE,AS REOUIRED BV SECTION
Q 370o OF THE L/�BOR CODE.FOR THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS O
ISSUED.MV WOR^KE7R-S�'QC�OMQPENSATION WSURANCE CARRIER AND POLICV NUMBER ARE: CON RUCTION / ��( 7
jCARqIER �I��/,L �N/7 p�
� POUCYNUMBER C7OC���GO ELECTRIC
� (iHSSECTIONNE�NOTBEODMiLFfIDOFhEPEfv.T�ISFORONEM.MDREDpCUJ�0.S(y100)ORLFSS} PLUMBING
W
Z I CERTIFV THAT IN THE PERFORA/ANCE OF THE WORN FOR WHICH THIS PERMIT IS ISSUED,I MECHANICAL
�} SHALL NOT EMPLOV ANV PERSON IN ANV MANNEfl SO AS TO BECOME SU&IECT TO THE
� NqRKERS'CAMPENSATqN LAWS OF CALIFORNIA,AND AGREE THAT IF 1 SHWLD BECOME E
SU6IECT TO THE WORKERS'COMPENSATION PROVISKKJS OF SECTION 370o OF THE UBOR
-rj CODE,I SHAU.FORTHWITM COMPLY WITHT/��gs�E PROVISIONS. � .
� —�5— ��C)DY�I� SMIP
p DATE: APPUCANT. Q S
W
J WARNING FAILUqE TO SECURE WORKERS'COMPENSATION COVERAOE IS UNLAWFUL,AND SHALL BE ENERGY.P/C
J
� SUBJECT AN EMPLOVER TO CRIM WAL PENALTIES AND CNIL FMES UP TO ONE HUNDRED THOUSAND ENERGY PE
DOLLAFiS(5100,000),IN ADDITION TO THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR IN
J SECTION 3]oe OF THE LABOR CODE,INTEREST,AND ATTORNEV'S FEES.
OC TENTION FEE��
OCONSTRUCTION�ENDING AGENCY p���
� I HEREBV AFFIRM UNDER PENALTV OF PER.IURV THAT THERE IS A CANSTRUCTION LENDINO A(3ENCY � '�
FOR THE PERFORMANCE OFTHE WORK FOR WHICH THIS PERMIT IS ISSUED(SEC.30G7,CIV.C.). ...-.-
Z �
w
� LENDEFS NAME
H LENDER'SADDRESS
W I CERTIFV THAT I HAVE qEAD THIS APPLICATION AND STATE THAT THE ABOVE INFOfU/ATqN IS CORRECT. TOTAL F E ES / O� �—�
� I AaREE TO COMPLV WITH ALL CITV ANO COUNTY ORDINANCES AND STATE UWS flEUTWG TO BUILDINO `
� CONSTRUCTION,ANDHEREBVAUTHORIZEREPRESENTATIVESOFTHISCWNTYTOENTEHU70NTHE
Z ABOVE�MENTIONED PROPERTV FOR INSPECTION PURPOSES. COMMENTS '
� ���y �1l
J
�
m PEFMITTEE NAME - '
¢ ,�,�P� ll-l�io
�
� SIONATUREOF EE DATE
= RECPT.NO. PAID BY VALIDATION
~ WHITE—Department Copy,YELLOW—Finence Copy,PINK—Assesam Copy,60LDENROD--File Copy,GREEN—Applicant's Copy
COTY C�� DI,�MC��1D B�,Fi
I.�S�EC�IOY� C�ECORD
. � , _� . , � ,: � . : <��
.� -���p��400a : .r�a4� �a�a�c�a oa�p�c�ooa =���� � �������;��
SET BACK ' FLOOR JOIST
FTGS/FORMS/STEEL FHA REQMTS
ELECTRIC GROUND UNDER FLOOR DUCT
GROUND PLUMBING UNDER FLOOR CONDUIT
SLAB GRADE FIREPLACE FOUNDATION
TEMP POWER FIREPLACE BOND BEAM
WATER SERVICE MID H'L BOND BEAM
ROOF SHEATHING � 8 FT. BOND BEAM
FRAMINGNENTILATION FINAL BOND BEAM
ROOF COVER PRE-GRADING
ROUGH HEATING BENCHING
ROUGH ELECTRIC ROUGH GRADING
ROUGH PLUMBING FINISH GRADING
SHOWER/TUB TEST POOL ELECTRIC
EXT. LATH/SIDING POOL FENCING
WALL INSULATION POOL FINAL
CEILING INSULATION �FF SITE IMPS.
DRYWAI�NAILING DEDICATIONS
SEWER FINAL ENG.
SEPTIC TANK LANDSCAPE/IRRIG.
SEEP PIT/L.L. ON SITE IMPS.
GAS AIR TEST FINAL ZONING
FINAL CONST. FIRE DEPT. FINAL
FINAL HEATING HEALTH DEPT. FINAL
FINAL ELECTRIC DEV. FEES PAID
FINAL PLUMBING ENERGY
���
COMMEfVTS ��-�' -��a�� d
SEPTIC TANK SIZE �
SEEP PIT/U SIZE
a
c� a
a
